Inspection on 27/04/07 for Alexandra Homes (Bristol) Ltd

This inspection was carried out on 27th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra Homes (Bristol) Ltd 31/01/06

Alexandra Homes (Bristol) Ltd 17/08/05

Alexandra Homes (Bristol) Ltd 15/02/05

Alexandra Homes (Bristol) Ltd 31/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Honeybourne House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alexandra Homes (Bristol) Ltd 250 Wells Road Knowle Bristol BS4 2PN Lead Inspector Nicky Grayburn Key Unannounced Inspection 27th April 2007 09:30 Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Homes (Bristol) Ltd Address 250 Wells Road Knowle Bristol BS4 2PN 0117 9778423 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Alexandra Homes (Bristol) Ltd John Dennis Duggan Care Home 16 Category(ies) of Learning disability (16), Mental disorder, registration, with number excluding learning disability or dementia (16) of places Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate adults aged 18 - 45 with Learning difficulties. The home may not admit residents at a rate more than there are communal or en-suite bathroom/shower facilities available (based on no more than three residents per communal bathroom). 31st January 2006 Date of last inspection Brief Description of the Service: Alexandra Homes opened in May 2004. The home caters for adults, aged 18 45, with Aspergers syndrome, who require additional time and high staff support in order to learn ways for dealing with their condition and to live in an independent setting. There are sixteen registered places, at present twelve people are in residence. There are communal facilities, which are shared by all, including a dining area; two lounges; a kitchenette; and a patio garden. The home is set over three floors and is accessible by stairs and a lift. The house is residential in style and is in keeping with the neighbouring properties. The home is close to the local shopping centre and major public transport routes to the centre of Bristol. Alexandra Homes has its own transport for residents. The home holds copies of all inspection reports and has an available Statement of Purpose and Service User Guide. Alexandra Homes has a website which can be accessed to find out more information about the service as a whole at www.aspergercare.co.uk The home calculates their fees on a weekly basis. As of 27th April 2007, the range of fees is from £1,500 to £3,000 per week. Additional charges apply to transport costs, which is calculated against the residents’ Disability Living Allowance, if applicable. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Alexandra Homes key inspection and was carried out over two days. It was unannounced. The inspector met with many of the residents and staff, including the management team. There were no requirements or recommendations to follow up from the previous inspection. Prior to the inspection, previous records and reports held at the Commission for Social Care Inspection were read, such as the home’s Annual Improvement Plan and copies of the homes Self-Evaluation Questionnaires. The manager also completed the Commission’s ‘Pre-Inspection Questionnaire’ giving basic information regarding the service. The inspector looked at key documents; ate lunch with the residents; observed a residents’ support meeting; talked with residents, staff and management on a one-to-one basis; and undertook a tour of the property. 10 residents’ surveys and 8 relatives were analysed and form part of this report. Of the residents’ surveys, 7 were completed by the resident on their own, without support. Three residents were case tracked and the inspector spot-checked other residents’ records. Verbal and written feedback was given at the end of the inspection to the registered manager. What the service does well: There are many things this home does well. The structure and organisation of the home is solid and is under constant monitoring. There is an open and inclusive atmosphere for both staff and residents. The record keeping and organisation of documents is excellent. Prospective residents can visit the home on numerous occasions and are well assessed prior to moving in to ensure that the home can meet their needs. Residents are encouraged to develop their independent living skills whilst at Alexandra Home. They have choice about their daily routine and have a very individualised weekly ‘timetable’ so that they know what they are doing. Relationships within the home and with family and friends are well maintained, with personal relationships being supported and respected. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 6 Residents feel very comfortable about raising any concerns or complaints they have with the management. The home is very well presented and has a homely and comfortable feel to it. There are high levels of staff support, often working on a one-to-one basis with the residents. There is a consistent staff team which supports residents effectively. The staff are well supervised and can approach their seniors at any time. The home has an excellent quality assurance system, which is undertaken on a 6-monthly basis ensuring that the service is constantly improving. Residents made comments to the inspector throughout the inspection such as “[Alexandra homes is] marvellous, can’t fault it, never looked back”, “[there is] great community spirit, people pull together”, and “staff encourage you to do things”. Relatives’ comments from the survey’s question ‘What does the home do well?’ included “I think they have ‘got it right’ and are very successful in handling the Aspergers Syndrome” [They] “Meet people’s specific needs; encourage and support independence; provide modern, homely facilities which clients can personalise; liaise with family; are respectful and friendly to the clients and family members.” “Listens to the individual of the residents – hence a sense of being valued.” “..[he/she] is being encouraged to build up [his/her] life again.” “I do not worry about [him/her] because [he/she] is happier than I’ve ever know [him/her].” What has improved since the last inspection? Alexandra Home has an annual internal improvement plan which the management devise in order to improve their service. There has been a lot of redecoration within the home, which makes it feel more homely and comfortable. Residents chose the colours they wanted in their rooms. The home does not have a key worker system now, which has improved the residents’ relationships with many of the members of staff rather than focusing on their key worker. More staff have completed their National Vocational Qualification in Care helping residents to be better supported by a more competent staff team. There is now a kitchenette for residents to use to learn how to cook as part of their independent living skills, which they said they enjoy using. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 7 The residents have an in-house counsellor now. Most of the residents have one-to-one sessions with her on a weekly basis. Staff can also access this service ensuring that any problems can be resolved as quickly as possible. Residents participate in a reward system relating to their achievement of tasks and completion of their weekly timetable. This has proved to be successful and encouraging for the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. Prospective residents are given information about the home and the opportunity to visit and ‘test drive’ the home prior to moving in. Residents benefit from having a full assessment ensuring that their needs will be met. Contracts need to have full details of costs and fees so that residents are fully aware of how much they have to pay for things. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Alexandra Homes has a Statement of Purpose, which is available to prospective residents, their supporters and staff. The manager is currently updating parts of it to reflect current staffing levels and restrictions within the home, which will be sent to the Commission for Social Care Inspection. This has been discussed with the manager. In the hallway of the home, there is a copy of this along with the Resident’s Guide; the complaints procedure; the whistle blowing policy; the last Inspection Report; and the home’s most recent self-evaluation report. Copies of these can be obtained by asking a member of staff. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 10 There are 4 new residents living permanently at the home since the last inspection. The inspector spoke with the management and residents about the admission process, which is individualised depending upon the presenting needs. Residents spoke highly of being able to visit the home on a number of occasions; stay over night; meet the staff and residents and be fully involved in their assessment. The inspector read a report written by the Deputy manager after staying with a prospective resident in their previous placement to ensure that the home could meet their needs. The home ensures that a full assessment is carried out prior to admission including input from the relevant professionals often in the form of an Initial Care Planning Approach with the residents’ placing authority. The inspector read some of these whilst case tracking the residents. All of the surveys stated that they were asked if they wanted to move into the home and 8 out of 10 stated that they received enough information about the home to make an informed decision. Some residents added that they “searched a few homes to find this one”; “I was offered the opportunity initially to view the home as well as being introduced to both residents and staff”; “I got a resident’s guide”; and “I was moved in quite quickly so I only visited the home once.” The inspector viewed some of the residents’ contracts. These are in place and contain detail such as their room number, insurance details and length of notice to be given, but need to contain the fees which are payable to the home, along with any extra costs they are likely to incur, such as transport costs. The home is registered to accommodate up to 16 residents and currently 12 residents reside at Alexandra Homes. The staffing levels have increased proportionally. The manager will be contacting the Commission’s Central Registration Team regarding the building of two self-contained flats at the rear of the property to promote independent living. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10 Quality in this outcome area is excellent. Residents benefit from having excellent individual weekly plans reflecting changes and needs. Residents can make informed choices and take balanced risks within their lives with support from staff. Information held about the residents is treated with respect and residents can be assured that their confidences are kept. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents have an individual care plan according to their needs and behaviour. The home uses various methods of recording residents’ progress and developments ensuring that any changes are accommodated. This was discussed and the documents were read with the care coordinator. Within the care plans, details of behaviour which may challenge staff is documented along Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 12 side how to keep the resident safe and how to manage the behaviour. The plan is accessible to residents and each has a copy in their bedrooms. Risk assessments regarding the residents’ safety are kept within the residents’ files. Some date from 2005, some from 2007. Staff must remember to review these as necessary to reflect current risks. Staff are now also being trained to write some risk assessments as part of their training and to ensure that they are fully aware of the risks involved in certain activities. It is noted when the risk is dependant upon the residents’ choice. The second manager has responsibility for the finances for the residents. The Pre-Inspection Questionnaire stated that 10 residents handle their own finances and 6 maintain their own benefit book. This manager is an appointee to only one resident. This was confirmed through discussion and looking through the finance file. Each resident has their own method of handling their finances. The majority of residents have budgeting skills and told the inspector about how they save and manage their monies. It was observed how residents could request support in this area. One resident’s finances were checked and were correct. The manager supports and encourages residents to handle their own finances by helping them to open bank accounts and change institutional methods. Even though this may be a long process, it is commendable. Some residents have advocates to help them voice their opinions. The manager is aware of this need and seeks external support when necessary. An advocate will be sought for one particular resident in the near future. Residents told the inspector about their monthly meetings and that “most [residents] come most of the time”. Residents felt that it was a “chance to say/talk about issues”. Minutes were also read by the inspector, which corresponded to what the residents had said. Management then write a formal response to the residents addressing the issues raised. This is good practice. Residents’ confidences are maintained. It was observed through interactions between staff and residents how sensitive issues are talked through away from other residents. Staff always closed the door when talking to the inspector about residents. Within staff personnel files, staff have signed a confidentiality statement and within residents’ contracts it explains about what measures are taken regarding their personal information. The manager also told the inspector that staff are aware that not all of the residents’ information and discussions are shared with their supporters dependant on their wishes. This assures the residents that their privacy is respected. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. Residents have excellent opportunities for personal development and access to the local community facilities in order to participate in appropriate leisure activities. Residents are well supported to maintain good contact with their family, friends, and personal relationships. Residents’ individual routines are extremely respected and recognised as an integral part of their lifestyle. A healthier and more nutritional diet would benefit residents. This judgement has been made using available evidence including a visit to this service. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 14 EVIDENCE: There are many opportunities for personal development at Alexandra Homes. Some of the residents have part time jobs, which they told the inspector about. Residents also have the opportunity to undertake a National Vocational Qualification due to the home being an approved centre for assessment. Many residents also attend local colleges and do courses, which help with their education and development. Residents told the inspector about all the many things that they do and greatly enjoy. Residents can participate engage in a wide variety of activities. This was detailed in the Pre-Inspection Questionnaire, in residents’ weekly plans; then confirmed through talking with the residents and staff; and observations. Trips are planned to go out into the community and wider area to visit certain places of interest and/or friends and family. For example, during the inspection, residents went bowling, to the cinema, walked to the local shops, went to college, visited friends and family members, and went camping for the weekend. Residents benefit from access to 3 minibuses which the staff drive (4 staff in each team can drive these). Camping trips are planned through the year, and further holidays are taken in small groups with support from staff. If residents do not wish to go away, day trips are planned, such as to art galleries and museums in London, going on a barge for the day; and car shows. A relative added on their survey that residents have “freedom to go on short trips on their own, and longer trips under supervision.” All the residents stated in their surveys that they could do what they want during the day and at the weekends. A new trip is to have specific ‘boys’ and ‘girls’ nights out, which residents spoke very positively about. There are details within the residents’ care files regarding their relationships with family and friends. From the relative’s surveys, 5 out of 8 stated that the home ‘always’ helps the resident to keep in touch with them, 2 stated ‘sometimes’, and 1 stated ‘never’. Some added comments such as “contact is encouraged by the home”; “whenever **** wants to visit us they drive him to an agreed meeting place.” Monthly summaries record how many times the resident rang home or visited family and/or friends. It was evident from the risk assessments, talking with staff and residents that personal relationships outside the home are maintained and are supported by staff. Stemming from a staff’s idea, the home is having a barbeque in the summer for residents, relatives and friends. Residents’ weekly plans are very individual and reflect their personal needs and routines. Due to the individuality of the plans, these can be altered at short notice depending on changing needs. Time is allocated for ‘chores’ such as cleaning their rooms; doing their laundry; seeing friends; going to college. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 15 Staff use the residents’ preferred name. Residents can access all areas of the home (apart from the kitchen; the laundry room; and the two offices). Those residents with religious beliefs are supported to maintain these. Visitors come to the home to see those residents. The inspector spoke with one of these and confirmed that they can visit the home, are welcomed and see the resident in private. The manager confirmed that all the residents received their voting cards for the local elections. It was up to the residents whether they used them or not, and would have been supported to go to the polling station. The inspector did not discuss this with the residents. The inspector ate lunch with the residents on both days of the visit. The inspector spoke with residents, relatives and staff about the provision of meals, viewed the kitchen fridges and freezers, read the menus and read what some residents have eaten over a four-day period. The kitchen is locked due to some residents’ obsessions around food. Some residents have their own menu to help them with their specific dietary needs. Many of the residents have allocated days to be supported to plan, buy the foods and cook their own meals (lunch and dinner) in the smaller kitchen in accordance with their independence living skills. Some residents really enjoy this. Meal times are relaxed and residents can choose whether they want to join the other residents or not, which is then documented in their daily record. The menu viewed was not particularly healthy but had variation. The inspector viewed the records for the past 4 days of what a resident ate, which included burger in a bun, fish fingers, chicken salad, potato wedges, doughnut, coke, roast beef, an egg and bacon roll, biscuits and sweets. Those residents with a specific diet have a separate freezer drawer for their needs. Residents can purchase their own foods and can be kept in the kitchen in their own ‘baskets’. Some residents told the inspector that the “food is nice”, and others said, “It is horrible”. There is no alternative meal provided if the resident doesn’t like the offered meal, which some residents told the inspector about and was observed. Two relatives told the inspector that they would like to see an improvement in this area, and suggested that the home employs a cook. The deputy manager said that the home doesn’t feel that there is a need for a cook due to the high numbers of staff. The care staff do the cooking. This standard was discussed with the manager regarding promoting healthy eating and nutritional intake and a requirement has been made. Residents are weighed weekly, which could be seen as institutional. It is documented in the care plans for those residents who have issues around their Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 16 weight. Staff said that residents often enjoy this time as it individual attention. Smoking is only allowed outside of the house. Some residents would like some kind of shelter for the colder months, which is brought up in every residents’ meeting. The idea is not entertained by the management. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. Residents benefit from staff supporting their personal needs in a way they prefer and require. Residents can be assured that their healthcare and emotional needs will be met Residents are protected by a robust medication system. Residents can be assured that their family and friends will handle their wishes at the time of death. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are encouraged to increase their independence skills whilst living at Alexandra Homes. There are details in their files regarding the level of support they require for personal care and hygiene. There are also details of the residents’ likes and dislikes regarding food and activities. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 18 It was observed how residents could get up in the morning when they want. A resident told the inspector that it is up to them if they want to get up to attend things such as college, but can ask for support with this. Residents told the inspector, was informed through the residents’ surveys, and it was discussed with the manager how residents have to be in their rooms by 10.30pm. This ‘expectation’ needs to be written in the home’s Statement of Purpose to ensure that prospective residents are fully aware of the rules of the home. The manager said that exceptions can be made but the rule is to encourage a routine for residents. Two surveys stated that they cannot do what they want in the evenings because of this expectation and stated that they “want to do more in the evenings”. It was evident from observations that residents can choose their own appearance reflecting their personalities. Alexandra Homes do not use a key worker system any longer. This was changed about 6 months ago due to residents needs. Staff told the inspector that some residents became very focused and dependant upon their key worker, which disabled them to carry out tasks on days when they were not working. Residents can now approach any of their support workers. A member of staff said that the “current way is a lot more pragmatic”. Residents said that they like the new way as they got to know other staff members now and feel that they can talk to more staff now. Staff’s supervision notes also evidenced that staff prefer this way of working. Details of residents’ health care needs are explained and recorded effectively. It was evident that appointments are regular. Residents told the inspector that when they do not feel well, they tell the staff and arrangements are made. This was further confirmed by the relatives’ surveys. The inspector spoke with one of the senior support workers about the medication process. The medication is kept in a locked cupboard on the ground floor. No residents self-administer their medication. There are no controlled drugs kept on the premises. Some residents are do not take any medication. Only the senior support workers administer the medication after training with the home’s pharmacy. Staff also attend a course at a local college to ensure that they have a more in-depth knowledge of the medication, such as what it is for, and the possible side effects. This training is refreshed annually. There is a robust procedure in place for reporting errors, which the senior explained. When residents go away, staff sign over the medication to the person who is looking after the resident. There are records of the medication coming in and out of the home ensuring there is a current stock list of what is held in the home. The senior said that their pharmacy is very helpful and they can fax them urgent orders, and ring for any advice if need be. Homely remedies such as paracetamol, and medication which is administered as and when necessary is recorded on the back of the Medication Administration Record sheets. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 19 The inspector spoke with the manager regarding the residents’ wishes at time of death. He said that these are not recorded as all the residents have supporters who would be contacted who would deal with the arrangements. It was discussed how this is a sensitive way of dealing with this issue due to the residents’ needs. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. Residents are extremely comfortable with raising concerns and complaints and are assured that they will be listened to and their views acted on. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a comprehensive and clear complaints policy and procedure, which can be easily found in the hallway; in the residents’ guide, and the residents’ contract. It states that the home will write to the complainant within 3 days and if necessary meet within 10 days to ensure that it is resolved. It includes contact details of the Commission for Social Care Inspection and also the local ombudsman. It was reviewed in January 2007. The inspector read the complaints book, which is bound to ensure that complaints don’t go missing. This book corresponds to the forms that residents fill out. One complaint wasn’t completed which was explained by the deputy manager. All the others were followed up. In the last 3 months, there have been 3 complaints made by the residents. The home is very open to suggestions for improvements. There have been no official complaints received by the Commission for Social Care Inspection since the last inspection. However, the inspector followed up some concerns from relatives with the manager and relevant external Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 21 professionals. This is being dealt with with the inclusion of external professionals. From the surveys received from the residents, all ticked that they knew who to speak to if they were unhappy, and all ticked that they knew how to make a complaint. Some residents added “there are always staff on hand if I wished to complain about situations, there are forms available if you want to make an official complaint.” and “ I have never had to make a complaint here, and we are always treated well.” Residents confirmed this, and told the inspector that they would talk to staff or the manager. It was also observed how residents feel comfortable with raising issues with staff. From the relative’s surveys, 5 out of 8 know how to make a complaint. It is recommended that the manager ensures that all residents’ supporters know how to make a complaint. One relative added “I would feel confident to approach the managerial team.” Further, 5 relatives stated that the service ‘always’ responded appropriately when they or the resident raised a concern. Added comments were “where [he/she] has raised concerns, [he/she] has been listened to respectfully and action has been taken to meet [his/her] needs.” Staff undertake Protection of Vulnerable Adults (PoVA) training within their induction period. Prior to starting work at the home, all staff have Enhanced Criminal Records Bureau checks, to ensure that residents are protected, some of which were seen by the inspector. It was discussed with the manager that some new staff work on a one-to-one basis before being trained in PoVA and how it must be risk assessed and reviewed. Staff’s NVQ also covers this subject. Staff have access to the Whistle Blowing policy empowering them to respond to suspicion or evidence of any abuse. Incidents involving residents are recorded and reported to the Commission for Social Care Inspection and the appropriate professionals. The previous inspection report stated that there are policies in place for the protection of vulnerable adults but was not read during this visit. The manager and the deputy attended further training in the PoVA for managers the day after the inspection. 7 out of 10 of the residents’ surveys stated that the staff ‘always’ treat them well with the other 3 stating ‘usually’. One resident added “the staff are wonderful in this place. They always listen to your problems.” Residents told the inspector “no-ones bullied, there are arguments, but no problems.” From incidents, which have been reported, staff are very aware of potential problems and deal with them effectively. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. Residents enjoy living in a homely, comfortable and clean environment. Residents have en-suite bathrooms providing sufficient privacy. Communal areas compliment residents’ personalised bedrooms. Aids and adaptations are installed to maximise residents’ independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Alexandra Home is a large house, which blends in well with the neighbouring properties. It is close to local amenities and local transport routes. There are four storeys with bedrooms on all floors. There is a lift, but staff said that they only use it for taking heavy items upstairs. The inspector undertook a tour of the house. There has been much re-decoration in the home since the last inspection, which was detailed in the Pre-Inspection Questionnaire, such as 4 Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 23 en-suite showers being installed in resident’s rooms; and a kitchenette has been fitted for resident’s independence living skills. There are 2 lounges, which have a television and a DVD player for residents to use. The computer with Internet access is soon to be returned to one of the lounges. There is a fish tank in one of the lounges, which is looked after by one of the residents, which was clean and residents find it relaxing. There is a large dining area, which overlooks the patio garden, which has tables and chairs which residents use often. The improvement plan states that this furniture is due to be replaced. There is also a barbeque, which the residents said they used at the weekend and enjoyed themselves. Residents have their own bedroom, which is lockable and residents tend to lock their room when they are out. The inspector went into six bedrooms mainly with the resident’s permission, who were proud to show the inspector their belongings. All were very personalised and clean. Residents have a designated morning to clean their room, with support if needed. Residents told the inspector if they had had their bedroom recently decorated and how they choose the colours. A relatives survey added, “The home is a pleasant, friendly place. The rooms are well decorated and furnished.” One bedroom is now being used as a specific counselling room. As well as the vast majority of the residents having their own en-suite bathrooms, residents can also use separate bathrooms to have a bath if they wish. These were clean, light and fresh. The kitchen is large and has industrial sized appliances. There is a communication book for staff to use regarding issues such as cleaning and defrosting the fridge and freezer. Temperatures of the fridges and freezers are recorded. The kitchen was clean. There are call buttons around the home and in residents’ rooms ensuring that residents and staff can call for assistance when needed. Staff and residents said that these are hardly ever used. Residents have use of a pay phone located in the hallway, which doesn’t offer total privacy. Many of the residents also have personal mobile phones. Where necessary, showers have been fitted with low-level entry and aids to help those residents with less mobility. There are two offices where records and documents are kept. The home was clean, light and free from offensive odours on both days of the inspection. It has a homely and relaxed atmosphere. 6 residents’ surveys stated that the home is ‘always’ fresh and clean, and 4 stated ‘usually’. Some Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 24 residents get frustrated with the cleanliness of the kitchenette. This was discussed with the deputy manager, and how residents are encouraged to do their own washing up to clean the sink out afterwards. There is a staff room for staff to store their personal belongings whilst on shift, and there are specific staff sleep-in rooms. One resident added on a survey “as regards to the home itself, it offers a most relaxed and friendly environment with amenities that are all within easy reach of the city itself. Its just great”. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is excellent. Residents are supported by an effective staff team who are well supported by the senior management. Residents are protected by the homes comprehensive recruitment practices. Qualified staff support the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are supported by a large staff team, with one-to-one support for the majority of the day, and at times two-to-one support. There are two teams who work on a shift rota. The organisational structure is clearly outlined in the home’s statement of purpose. The inspector talked with management; the care co-coordinator/counsellor; senior support workers; a team leader and support workers throughout the inspection and on a one-to-one basis. Individual staff’s files were also read. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 26 Staff appeared confident and were aware of their role within the home. Job descriptions were filed in staff records. The inspector observed over the two days, that staff were courteous, polite, and treated the residents with respect at all times. The inspector checked 4 staff’s records, 3 of whom started working at the home in the past few months. All contained a completed application form; 2 satisfactory references from previous employers; a self-declaration of fitness to work; a satisfactory enhanced criminal records bureau check; details of qualifications and training, and a contract of employment. There was no evidence of induction, which was discussed with the management. The manager assured that new starters go through an initial induction to the home and then they progress through all the policies, procedures and statutory training. The deputy manager showed the inspector the form they use to record staff’s induction, and said that some staff keep these for reference. These must be kept on file for evidence and reference. The manager told the inspector how some residents have recently been involved in interviewing of new staff. The pros and cons were discussed regarding this involvement. The Pre-Inspection Questionnaire stated that 74.9 of the care staff hold their National Vocational Qualification (NVQ) in care. The home is an approved NVQ assessment centre. The home has a low staff turnover with only 4 staff leaving since the previous inspection. No agency staff are used. This indicates that staff enjoy their working environment and are well supported. The home uses a training package called BVS which comes in the form of a DVD. The manager told the inspector that they had just purchased a further training package regarding Protection of Vulnerable Adults. Feedback regarding the training was mixed from the members of staff. It is advised that the home looks into resourcing external training to further enhance statutory training. Much of the training is also included within the NVQs. 4 out of 8 relatives consider that staff ‘always’ have the right skills and experience to look after their relative in the home, 2 stated ‘usually’, one stated ‘never’ and one didn’t answer this question. Added comments were “There appears to be an unusually good level of consistency and behavioural management.” And “it is my impression that a first class service is delivered which couldn’t be the case without the right skills and experience.” There is a supervision list of dates on the notice board so staff know when their session is. These dates matched the records held in the staff’s files. These were well written, thorough and supportive. Sessions also identify training needs. Issues, which have arisen regarding staffing practices, have been documented and dealt with appropriately. These corresponded with things residents had told the inspector. Staff confirmed that they have supervision Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 27 monthly or six-weekly, and also annual appraisals. The inspector viewed these in the staff files. The counsellor told the inspector that she has started observing staff’s interactions with resident to give feedback to improve approaches. Due to some of the challenges residents present, staff can now self-refer themselves to the counsellor to talk through any issues regarding residents. This indicates that staff are aware of their limitations and can identify areas for development. This practice is commendable. Due to the open ethos within the home, staff told the inspector that if there are any issues or problems, staff can approach any of the senior team for it to be resolved straight away rather than waiting for their supervision session. Staff also confirmed, and an example has already been actioned, that they are encouraged to bring forward any new ideas for the home. The senior management team meet up weekly and minutes are distributed to the whole staff team to maintain an open atmosphere. The inspector read the minutes for the past 4 meetings. A member of staff told the inspector that staff meetings occur monthly which are chaired by the senior support workers. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 Quality in this outcome area is excellent. Residents benefit from a well run home with good transparent systems in place to monitor the service. The excellent quality assurance systems ensure that residents and their supporter’s views are sought, acted on, and are involved in the development of the home. Residents can be assured that records are kept to safeguard the residents best interests. Residents are protected by safe working practices. This judgement has been made using available evidence including a visit to this service. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 29 EVIDENCE: As detailed in the home’s Statement of Purpose, the registered manager, Mr John Duggan, has a wealth of experience working in social care and in a managing role and has a number of qualifications suitable for managing the home such as a Post Graduate Certificate in Management and a Diploma in Social Work. The second manager, Leigh Burleigh, also has numerous years of experience and holds an NVQ level 4 in Management. Both managers were present during most of the inspection and responded to questions and queries confidently and professionally. Responsibilities are divided between the two senior managers and the Deputy Manager who was also most helpful throughout the inspection. Staff spoke positively about the management, with comments such as “stuff gets done, nothings swept under the carpet, things are followed up”. The home sends the Commission for Social Care Inspection much information about the running of the service and the inspector was able to locate all the required documents for the inspection. Staff were aware of systems and feel able to approach the management at any time. Minutes from the senior management team are circulated to the staff team. It was observed how residents could ask questions and approach senior management when they needed to. This evidences how there is an open and positive atmosphere within the home. The home has a comprehensive quality assurance system involving residents and their supporters. Questionnaires are sent out 6-monthly. The responses are then amalgamated for analysis. The management uses these to make any alterations to their service if need be. The inspector read the self-evaluation questionnaires from the past two surveys. The results are also sent to the Commission for Social Care Inspection. It is extremely pleasing to note that the vast majority of the relatives are extremely content with the service, with comments such as “Alexandra Homes is a God send”. Further, all the residents the inspector spoke with, shared the same views as the relatives. The home has various forms of monitoring residents’ records ensuring that all required documents are completed and any anomalies are picked up straight away. The inspector met the Registered Responsible Person, Mr Gordon Rowe, and discussed Regulation 26 visits. It was agreed that these reports will be sent to the Commission for Social Care Inspection on a monthly basis. The last one was received in August 2006. The majority of the records are kept up-to-date and are excellently organised. Many reports and documents are signed by the resident to evidence that they Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 30 are aware of what is written about them. Records are kept safe either in a lockable cabinet in the main office or in the ‘duty’ office which is locked when no one is in there. The second manager is responsible for the health and safety of the home and records are well kept. The home has an external fire safety contractor to deal with any issues and to annually check the home. The last visit was in December 2006. Fire drills are regular (last one being 11/3/7) and problems are identified with actions being taken to resolve them. The fire risk assessment was audited in September 2006. Staff undertake the DVD training for fire safety along with the fire drills. The manager carries out the Portable Appliance Testing, with the next tests due in September 2007. Attention must be given to the weekly tests for fire safety equipment such as the fire extinguishers and the fire alarm. This was brought to the attention of the managers. Fire procedures are also on the back of resident’s bedroom doors and some residents told the inspector what they would do if they heard the alarm. The lift was serviced and passed in March 2007. The emergency call system is tested monthly. The home tests for Legionella disease and was passed in March 2007. The Employers Liability Insurance certificate is in date and on display in the hallway. The annual improvement plan details costs of the changes and improvements to the service. The inspector did not examine the financial viability of the home. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 4 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 3 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 4 32 4 33 4 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 4 LIFESTYLES Standard No Score 11 4 12 4 13 3 14 4 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 4 4 X 3 3 X Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1b) Requirement The Registered Person must ensure that each resident has a contract to reflect current fees and extra costs. The Registered Person must ensure that residents have a healthy, nutritional and balanced diet with a choice of meals. Timescale for action 30/06/07 2. YA17 16(2)(i) 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 Good Practice Recommendations To ensure that all residents’ supporters know how to make a complaint. Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra Homes (Bristol) Ltd DS0000060692.V337778.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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